急性缺血性轻型卒中早期神经功能恶化的危险因素初探

Investigation on risk factors in early neurological deterioration of acute minor ischemic stroke

目的探究急性缺血性轻型卒中早期神经功能恶化的危险因素。方法对2014年7月至2017年7月于本院确诊急性缺血性轻型卒中的患者进行筛选,纳入102例患者进行回顾性分析。按是否出现早期神经功能恶化将患者分为研究组(n=39)和对照组(n=63)。对两组患者的性别、年龄、既往病史、血压昼夜节律及其他临床资料进行对比研究,找出两组间的差异,并分析该差异是否为早期神经功能恶化的危险因素。结果发生早期神经功能恶化的研究组患者,血压节律异常发生率79.5%(31/39)、糖尿病发生率46.2%(18/39)、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)基线评分[2(2~3)]、脑大动脉狭窄发生率69.2%(27/39)、病因分型中大动脉粥样硬化性卒中发生率66.7%(26/39)、小动脉闭塞性卒中发生率20.5%(8/39)显著区别于对照组的52.4%(33/63)、23.8%(15/63)、1(1~2)、41.3%(26/63)、30.2%(19/63)及47.6%(30/63),差异有统计学意义(P<0.05)。Logistic回归分析显示,血压昼夜节律异常(OR=3.522,95%CI 2.285~5.431,P=0.001)、基线NIHSS较高(OR=2.037,95%CI 1.355-3.059,P<0.001)及脑大动脉狭窄(OR=3.202,95%CI 2.224~4.609,P<0.001)是急性缺血性轻型卒中早期神经功能恶化的危险因素。结论血压昼夜节律异常、基线NIHSS较高及脑大动脉狭窄是急性缺血性轻型卒中患者发生早期神经功能恶化的危险因素,对患者进行病因分型或有助于识别高危患者。

Objective To investigate risk factors in the early neurological deterioration of acute minor ischemic stroke.Methods Patients with acute minor ischemic stroke diagnosed in our hospital from July 2014 to July 2017 were screened,and 102 of them were included for this retrospective analysis.They were divided into control group(n=63)and study group(n=39)according to whether the patient had early neurological deterioration after admission.Their gender,age,history,circadian rhythm and other clinical data were compared to find out the difference between these two groups,and to investigate whether it was the risk factor in the early neurological deterioration of minor stroke.Results In the study group with early neurological deterioration,the abnormal rate of blood pressure rhythm was 79.5%(31/39),and the incidence of diabetes(46.2%,18/39),baseline NIHSS[2(2~3)],cerebral aortic stenosis(69.2%,27/39),largeartery atherosclerosis(66.7,26/39)and small-artery occlusion(20.5,8/39)were quiet different from those of the control group[52.4%,33/63;23.8%,15/63;1(1~2);41.3%,26/63;30.2%,19/63;47.6%,30/63].The difference was statistically significant(P<0.05).Logistic regression analysis showed that abnormal circadian rhythm of blood pressure(OR=3.522,95%CI 2.285~5.431,P=0.001),higher baseline NIHSS(OR=2.037,95%CI 1.355~3.059,P<0.001)and cerebral aortic stenosis(OR=3.202,95%CI 2.224~4.609,P<0.001)were risk factors in the early neurological deterioration of minor stroke.Conclusion Abnormal circadian rhythm of blood pressure,higher baseline NIHSS and cerebral aortic stenosis may be risk factors in the early neurological deterioration of acute minor ischemic stroke,and etiological typing of patients may help identify high-risk patients.